| NPI | 1912476334 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY DAVID LIVINGSTON Owner/Practitioner 307-578-8820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2018-12-26 |